We know what’s good for the “all” but we can’t say yet that we know what’s good for the “one.”

More evidence from experiments on mice on how and why exercise is good for People with Parkinson’s (PwPs):

The popularized article: Link between exercise and dopamine

And from the abstract and significance statement of the original (non-open access) article:

Physical exercise improves motor performance in individuals with Parkinson’s disease and elevates mood in those with depression. Although underlying factors have not been identified, clues arise from previous studies showing a link between cognitive benefits of exercise and increases in brain-derived neurotrophic factor (BDNF). (emphasis added).

and:

Exercise has been shown to improve movement and cognition in humans and rodents. Here, we report that voluntary exercise over 30 days leads to an increase in evoked dopamine (DA) release throughout the striatum, and an increase in BDNF in the dorsal (motor) striatum. The increase in DA release appears to require BDNF, indicated by the absence of DA release enhancement with running in BDNF+/- mice. Activation of BDNF receptors using a pharmacological agonist was also shown to boost DA release. Together these data support a necessary and sufficient role for BDNF in exercise-enhanced DA release, and provide mechanistic insight into the reported benefits of exercise in individuals with dopamine-linked neuropsychiatric disorders, including Parkinson’s disease and depression. (emphasis added).

The citation:

Voluntary exercise boosts striatal dopamine release: evidence for the necessary and sufficient role of BDNF, Guendalina Bastioli, Jennifer C. Arnold, Maria Mancini, Adam C. Mar, Begoña Gamallo-Lana, Khalil Saadipour, Moses V. Chao, Margaret E. Rice,Journal of Neuroscience 16 May 2022, JN-RM-2273-21; DOI: 10.1523/JNEUROSCI.2273-21.2022

So that covers why exercise is good for all. But what about what is good for the one? 

Farrow SL, Cooper AA, O’Sullivan JM. Redefining the hypotheses driving Parkinson’s diseases research. NPJ Parkinsons Dis. 2022 Apr 19;8(1):45. doi: 10.1038/s41531-022-00307-w. PMID: 35440633; PMCID: PMC9018840.

… there is growing recognition that PD is not a single entity but instead reflects multiple diseases, in which different combinations of environmental, genetic and potential comorbid factors interact to direct individual disease trajectories… The clear consequence of there being distinct diseases that collectively form PD, is that there is no single biomarker or treatment for PD development or progression. We propose that diagnosis should shift away from the clinical definitions, towards biologically defined diseases that collectively form PD, to enable informative patient stratification. N-of-one type, clinical designs offer an unbiased, and agnostic approach to re-defining PD in terms of a group of many individual diseases. . (emphasis added).

The citation links to PubMed where you can download the full article, should you be so inclined. The next citation also links to an open access free article.

Riggare S, Hägglund M. Precision Medicine in Parkinson’s Disease – Exploring Patient-Initiated Self-Tracking. J Parkinsons Dis. 2018;8(3):441-446. doi: 10.3233/JPD-181314. PMID: 30124453; PMCID: PMC6130409.

In this article, Riggare reports on self tracking done in 2012 (as a Person with Parkinson’s), and the offer the possibility that self-tracking of symptoms and medications can help to inform the physician’s decisions over the course of treatment. In other words, one should be a self-advocate as a patient and work with your physician to achieve the best combination of treatments to address Parkinson’s and its comorbidities. (At least that’s my takeaway from the article. Others might differ).

Another look at PD aims to categorize it into various sub-types:

Mestre TA, Fereshtehnejad SM, Berg D, Bohnen NI, Dujardin K, Erro R, Espay AJ, Halliday G, van Hilten JJ, Hu MT, Jeon B, Klein C, Leentjens AFG, Marinus J, Mollenhauer B, Postuma R, Rajalingam R, Rodríguez-Violante M, Simuni T, Surmeier DJ, Weintraub D, McDermott MP, Lawton M, Marras C. Parkinson’s Disease Subtypes: Critical Appraisal and Recommendations. J Parkinsons Dis. 2021;11(2):395-404. doi: 10.3233/JPD-202472. PMID: 33682731; PMCID: PMC8150501.

This article is a “desk review”of other studies, using specific criteria to either include/exclude each study in the results. Their conclusion: 

Conclusion: Subtyping studies undertaken to date have significant methodologic shortcomings and most have questionable clinical applicability and unknown biological relevance. The clinical and biological signature of PD may be unique to the individual, rendering PD resistant to meaningful cluster solutions. New approaches that acknowledge the individual-level heterogeneity and that are more aligned with personalized medicine are needed. (emphasis added).

Among the articles cited in the bibliography is this one (another open access article):

Lawton M, Baig F, Toulson G, Morovat A, Evetts SG, Ben-Shlomo Y, Hu MT. Blood biomarkers with Parkinson’s disease clusters and prognosis: The oxford discovery cohort. Mov Disord. 2020 Feb;35(2):279-287. doi: 10.1002/mds.27888. Epub 2019 Nov 6. PMID: 31693246; PMCID: PMC7028059.

In this, the authors describe their methodology and results from the Oxford cohort (one of several cohorts of PwPs and controls that have been used for research. (I would take the time and effort to locate the original publication describing the different cohorts involved in the effort to find biomarkers, but I am currently experiencing a wave of Parkinson’s related apathy. Check my past posts, or do a search on PubMed – I do remember that Oxford and Boston were two of the cohorts of PwPs.  But I digress).

Results: Apolipoprotein A1 and C-reactive protein levels differed across our PD subtypes, with severe motor disease phenotype, poor psychological well-being, and poor sleep subtype having reduced apolipoprotein A1 and higher C-reactive protein levels. Reduced apolipoprotein A1, higher C-reactive protein, and reduced vitamin D were associated with worse baseline activities of daily living (MDS-UPDRS II).

Conclusion: Baseline clinical subtyping identified a pro-inflammatory biomarker profile significantly associated with a severe motor/nonmotor disease phenotype, lending biological validity to subtyping approaches. No blood biomarker predicted motor or nonmotor prognosis. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society. (emphasis added).

In other words: Close, but no cigar. But I, for one, certainly could have benefited from this knowledge had it been available 60 years ago. (don’t get me started – I’ve played that tape many times before).

Oh well, let’s end on a high note:

Basic human rights

I don’t have access to the content of this book, but I was struck by the abstract to this chapter:

The right to an education is an important human right and is regulated in considerable detail in Articles 13 and 14 of the International Covenant on Economic, Social and Cultural Rights as well as in Articles 28 and 29 of the UN Convention on the Rights of the Child. With the sole exception of the United States, all United Nations member States have accepted the right to education as a legally binding human right that needs to be implemented in their domestic systems. (emphasis added)

What’s wrong with education in the United States? The U.S.A. hasn’t accepted it as a legally binding human right. No wonder that (well, I won’t go there today).

Chapter: Music Education
Child Development and Human Rights
By Steven J. Holochwost, Elizabeth Stuk

The book citation is:
Fifer, J., Impey, A., Kirchschlaeger, P.G., Nowak, M., & Ulrich, G. (Eds.). (2022). The Routledge Companion to Music and Human Rights (1st ed.). Routledge https://doi.org/10.4324/9781003043478
eBook ISBN 9781003043478

Book Description
The Routledge Companion to Music and Human Rights is a collection of case studies spanning a wide range of concerns about music and human rights in response to intensifying challenges to the well-being of individuals, peoples, and the planet. It brings forward the expertise of academic researchers, lawyers, human rights practitioners, and performing musicians who offer critical reflection on how their work might identify, inform, or advance mutual interests in their respective fields. The book is comprised of 28 chapters, interspersed with 23 ‘voices’ – portraits that focus on individuals’ intimate experiences with music in the defence or advancement of human rights – and explores the following four themes: 1) Fundamentals on music and human rights; 2) Music in pursuit of human rights; 3) Music as a means of violating human rights; 4) Human rights and music: intrinsic resonances.

The book is scheduled for publishing on May 31, 2022. $250 for print, under $50.00 USD for ebook format.

I really gotta look into becoming a student or getting associated with an organization or library that would allow me to access research articles, journals, ans books. It’s the one thing I miss most about IBM: access to technical journals through the library. That, and the IBM Club band, aka the Blue Diamonds Jazz Orchestra (BDJO). 

While not exactly fitting in with music, but maybe under basic human rights (free speech, anyone?), here is an open access article reporting on the results of the Parkinson’s Voice initiative:

Conclusion first:

Sustained vowels may provide an objective, robust and streamlined approach towards informing PwP subtype assignment. The current study’s findings corroborate part of the PD research literature indicating the presence of four PD subtypes having been thoroughly validated on a large PwP cohort and externally validated on two additional PwP cohorts. There are important practical implications of defining PD subtypes using data that is easy to self-collect remotely such as speech signals and in particular sustained vowel /a/ phonations: they enable large-scale investigations and may bring us a step closer towards more personalized medicine approaches and targeted clinical management. The key limitation of the study is that we do not have additional clinical labels (e.g. UPDRS) or other self-reported outcome measures to map the resulting PD subtypes onto something that would be more tangible and comparable to related PD subtype studies. Future work could explore the extent subtypes form useful markers of symptom severity progression and conversely how PD progression might affect subtype membership for individual PwP. Similarly, further work could integrate additional modalities to speech to incorporate longitudinal passively collected modalities and self-reports which could be capturing PD-related symptoms, e.g. via using smartphones and wearables along the lines we have explored for mental disorders [64], [67]–[70]. Collecting additional modalities at scale using increasingly affordable technologies may provide new insights towards understanding PD subtypes which may translate into understanding individual PwP similarities, related PwP symptom trajectories, and ultimately lead to better symptom management strategies.

and from the abstract:

Purpose
People diagnosed with Parkinson’s (PwP) exhibit a diverse manifestation of heterogeneous symptoms which likely reflect different subtypes. However, there is no widely accepted consensus on the criteria for subtype membership assignment. We explored clustering PwP using a data-driven approach mining speech signals.

Results
We selected 21 dysphonia measures and found four main clusters which provide tentative insights into different dominating speech-associated characteristics (cophenetic coefficient=0.72, silhouette score=0.67). The cluster findings were consistent across the three PVI cohorts, strongly supporting the generalization of the presented methodology towards PwP subtype assignment, and were independently visually verified in 2D projections with t-SNE.

The citation (and the link to access) this open access article are:

Tsanas, T & Arora, S 2022, ‘Data-driven Subtyping of Parkinson’s using Acoustic Analysis of Sustained Vowels and Cluster Analysis: Findings in the Parkinson’s Voice Initiative Study’, SN Computer Science, vol. 3, 232. https://doi.org/10.1007/s42979-022-01123-y

and that’s all I have for today, folks!

###

More research on Dance

Not a lot to discuss: just a bunch of articles from the last couple of years.

Bearss KA, DeSouza JFX. Parkinson’s Disease Motor Symptom Progression Slowed with Multisensory Dance Learning over 3-Years: A Preliminary Longitudinal Investigation. Brain Sci. 2021 Jul 7;11(7):895. doi: 10.3390/brainsci11070895. PMID: 34356129; PMCID: PMC8303681.

Bek J, Groves M, Leventhal D, Poliakoff E. Dance at Home for People With Parkinson’s During COVID-19 and Beyond: Participation, Perceptions, and Prospects. Front Neurol. 2021 May 31;12:678124. doi: 10.3389/fneur.2021.678124. PMID: 34140925; PMCID: PMC8204717.

Fontanesi C, DeSouza JFX. Beauty That Moves: Dance for Parkinson’s Effects on Affect, Self-Efficacy, Gait Symmetry, and Dual Task Performance. Front Psychol. 2021 Feb 5;11:600440. doi: 10.3389/fpsyg.2020.600440. PMID: 33613357; PMCID: PMC7892443.

Emmanouilidis S, Hackney ME, Slade SC, Heng H, Jazayeri D, Morris ME. Dance Is an Accessible Physical Activity for People with Parkinson’s Disease. Parkinsons Dis. 2021 Oct 22;2021:7516504. doi: 10.1155/2021/7516504. PMID: 34721836; PMCID: PMC8556098.

Christensen-Strynø MB, Phillips L, Frølunde L. Revitalising sensualities of ageing with Parkinson’s through dance. J Aging Stud. 2021 Dec;59:100978. doi: 10.1016/j.jaging.2021.100978. Epub 2021 Oct 23. PMID: 34794724.

Krotinger A, Loui P. Rhythm and groove as cognitive mechanisms of dance intervention in Parkinson’s disease. PLoS One. 2021 May 6;16(5):e0249933. doi: 10.1371/journal.pone.0249933. PMID: 33956853; PMCID: PMC8101757.

Bar A, Czamanski-Cohen J, Federman JD. I Feel Like I Am Flying and Full of Life: Contemporary Dance for Parkinson’s Patients. Front Psychol. 2021 Jul 5;12:623721. doi: 10.3389/fpsyg.2021.623721. PMID: 34290638; PMCID: PMC8287013.

Gyrling T, Ljunggren M, Karlsson S. The impact of dance activities on the health of persons with Parkinson’s disease in Sweden. Int J Qual Stud Health Well-being. 2021 Dec;16(1):1992842. doi: 10.1080/17482631.2021.1992842. PMID: 34694957; PMCID: PMC8547839.

Bevilacqua R, Benadduci M, Bonfigli AR, Riccardi GR, Melone G, La Forgia A, Macchiarulo N, Rossetti L, Marzorati M, Rizzo G, Di Bitonto P, Potenza A, Fiorini L, Cortellessa Loizzo FG, La Viola C, Cavallo F, Leone A, Rescio G, Caroppo A, Manni A, Cesta A, Cortellessa G, Fracasso F, Orlandini A, Umbrico A, Rossi L, Maranesi E. Dancing With Parkinson’s Disease: The SI-ROBOTICS Study Protocol. Front Public Health. 2021 Dec 21;9:780098. doi: 10.3389/fpubh.2021.780098. PMID: 34993171; PMCID: PMC8724049.

Ismail SR, Lee SWH, Merom D, Megat Kamaruddin PSN, Chong MS, Ong T, Lai NM. Evidence of disease severity, cognitive and physical outcomes of dance interventions for persons with Parkinson’s Disease: a systematic review and meta-analysis. BMC Geriatr. 2021 Sep 22;21(1):503. doi: 10.1186/s12877-021-02446-w. PMID: 34551722; PMCID: PMC8456607. (This is a desk review of articles rather than original research. Personally, I am skeptical of the conclusions of such reviews [unless they support my biases, of course]).

Hsu P, Ready EA, Grahn JA. The effects of Parkinson’s disease, music training, and dance training on beat perception and production abilities. PLoS One. 2022 Mar 8;17(3):e0264587. doi: 10.1371/journal.pone.0264587. PMID: 35259161; PMCID: PMC8903281.

Walton L, Domellöf ME, Åström ÅN, Elowson Å, Neely AS. Digital Dance for People With Parkinson’s Disease During the COVID-19 Pandemic: A Feasibility Study. Front Neurol. 2022 Feb 3;12:743432. doi: 10.3389/fneur.2021.743432. PMID: 35185746; PMCID: PMC8850348.

Izbicki P, Stegemöller EL, Compton J, Thompson J. Dancing for Parkinson’s: A Gateway for Connectedness to Peers and Social Assurance. CBE Life Sci Educ. 2021 Jun;20(2):ar27. doi: 10.1187/cbe.20-05-0101. PMID: 33944618; PMCID: PMC8734394.

Sundström M, Jola C. “I’m Never Going to Be in Phantom of the Opera”: Relational and Emotional Wellbeing of Parkinson’s Carers and Their Partners in and Beyond Dancing. Front Psychol. 2021 Jul 29;12:636135. doi: 10.3389/fpsyg.2021.636135. PMID: 34393878; PMCID: PMC8358682.

Carapellotti AM, Rodger M, Doumas M. Evaluating the effects of dance on motor outcomes, non-motor outcomes, and quality of life in people living with Parkinson’s: a feasibility study. Pilot Feasibility Stud. 2022 Feb 9;8(1):36. doi: 10.1186/s40814-022-00982-9. PMID: 35139914; PMCID: PMC8827282.

Mele B, Ismail Z, Goodarzi Z, Pringsheim T, Lew G, Holroyd-Leduc J. Non-pharmacologic interventions to treat apathy in Parkinson’s disease: A realist review. Clin Park Relat Disord. 2021 May 25;4:100096. doi: 10.1016/j.prdoa.2021.100096. PMID: 34316673; PMCID: PMC8299975.

Kang SH, Kim J, Kim I, Moon YA, Park S, Koh SB. Dance Intervention Using the Feldenkrais Method Improves Motor, and Non-Motor Symptoms and Gait in Parkinson’s Disease: A 12-Month Study. J Mov Disord. 2022 Jan;15(1):53-57. doi: 10.14802/jmd.21086. Epub 2021 Nov 3. PMID: 34724780; PMCID: PMC8820889.

And there you have it. A bunch of research or reviews over the last year and a half involving dance and Parkinson’s Disease. I did a search and haven’t had enough time to read any of these yet, but That’s part of the reason for this blog: to serve as a repository of links to articles. All of these are open access articles so the full text should be available.

Meanwhile… 

Improv revisited

Today I’ll look back at a previous post: Pre-clinical trial starts February 26.

Or not.  Instead, I’ll do my best not to violate the NDA we signed about the trial, and look instead at oh, say, humor and Parkinson’s Disease (PD).

As one of my graduate professors mentioned to our class, humor is best when it is “in the moment,” spontaneous, and not planned, often helping to release the tension of what could be an awkward moment.

I’ll refer to the interview conducted by Power for Parkinson’s earlier this month with the PhD. candidate who was conducting the trial noted above. In it, he lays out the concepts and the parameters of the studies, and the three folks in the interview play some of the exercises.

Powerful People interview with Robert Cochrane

The home site for the program is yesandexercise.org.

I actually participated in the clinical trial noted in the previous post and felt that it helped me recognize some things about myself as a Person With Parkinson’s and my interactions with the rest of the world. Still have the same issue of people of thinking I’m serious when I’m jesting, and vice versa, though. And knowing just how far to go with it and when to shut my mouth (or press delete instead of send). It’s a work in progress… or an abandoned house/wisecrack house/fixer-upper. Take your pick.

and, just for today, we’ll end in a prayer:

Forgive, O Lord, my little jokes on Thee
And I’ll forgive Thy great big one on me.

      • Robert Frost

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Keep on Dancing, folks!

Conclusions first:

Conclusions
This study highlighted the challenges associated with the feasibility of using an RCT design in this setting, demonstrated the acceptability of implementing a dance program inspired by the Dance for PD® model in Belfast, Northern Ireland for people living with Parkinson’s, and made suggestions for future research. The results support existing evidence demonstrating that dance may improve functional mobility and symptoms of depression in people living with mild to moderate Parkinson’s, though these findings should be carefully interpreted in the context of the study design and limitations. The small sample size limits the generalizability of the statistical results, though it was not among the aims of this study to test the efficacy of the intervention. The findings also support the idea that meeting and dancing with other people living with Parkinson’s is motivating and fosters a sense of belonging, and that dancing has the potential to support several aspects of physical, emotional, mental, and social health. (emphasis added).

Working back in the article, the authors are very honest about the limitations, including not being able to  establish a large enough group of participants so that they might be able to compare the dance intervention against another form of exercise.

Only ten Parkinson’s Disease diagnosed participants were recruited, which makes generalization difficult, but modest improvements were seen. (I saw no mention of statistically significant results in the 12 week, 20 session study). Some participants noted that the dance intervention made them more aware of certain deficits, such as posture, and that the classes motivated them to make more mindful efforts to correct these outside of the classes.

Some participants also described using tools learned in class in everyday life. For example, one participant reported using breathing exercises when anxious or fatigued, and another reported using the warm-up exercises outside of class to “stop the stiffness” and “feel better as a result of that. (emphasis added).

So: Small number of participants. Some improved scores, but no statistically significant differences. Positive statements from exit interviews. Nothing to contradict other evidence that dance interventions have a positive effect on the lives of people with Parkinson’s Disease.

Don’t stop moving to the music / keep on dancing,  folks

The article is open access and may be downloaded for free at:

Evaluating the effects of dance on motor outcomes…

Citation for this article:

Carapellotti, A.M., Rodger, M. & Doumas, M. Evaluating the effects of dance on motor outcomes, non-motor outcomes, and quality of life in people living with Parkinson’s: a feasibility study. Pilot Feasibility Stud 8, 36 (2022). https://doi.org/10.1186/s40814-022-00982-9

Participants needed for Narrative Study in Parkinson’s Disease – study starts February 26, 2022

Robert Cochrane is recruiting participants for a new Parkinson’s Disease study. See below. Note the three categories of PD people needed:
” We are recruiting male and female persons diagnosed with idiopathic (unknown cause) Parkinson’s disease between and fit ONE of the following criteria:
– They have been diagnosed within the last year,
– are early onset (diagnosed before the age of 50)
– are active or former members of the U.S. military. “”
Here’s the full recruitment flyer:
Participants needed for Narrative Study in Parkinson’s Disease Principal Investigator, Dr. Gabriele Wulf, and Robert Cochrane, PhD student at UNLV, are looking for persons with Parkinson’s disease to participate in an online research study of heroic narrative upon Parkinson’s disease. Study participants will be asked to share their perceptions and experiences about Parkinson’s from the time they were diagnosed to today, and how they feel about their future quality of life expectations. They will be taught heroic storytelling structure and practical tools of how to explore and incorporate it into their own lives. Heroic storytelling is based on the works of Joseph Campbell’s monomyth. Campbell’s work is broken into a 12-step journey for this class that participants will follow and use to write their own heroic journey with Parkinson’s disease. Participation in this study will require completion of 12 sessions, meeting once a week on Saturday mornings from 9a-10:30a (Pacific Time). Participants Will also be required to write a one-page personal assessment each week outside of class. Finally,online surveys at the beginning, middle and end of the 12-session period will be required. All sessions will take place online via Zoom. All sessions will be recorded. Participants must have a WiFi enabled device in a safe location (e.g. participants’ home) for these sessions. Sessions will include writing, theatrical improvisation and lectures from guest subject matter experts in fields such as dance, art and mythology. We are recruiting male and female persons diagnosed with idiopathic (unknown cause) Parkinson’s disease between and fit ONE of the following criteria:
– They have been diagnosed within the last year,
– are early onset (diagnosed before the age of 50)
– are active or former members of the U.S. military. Participants must be between 1-3 on the Hoehn and Yahr scale. This assessment should be given by participants’ neurologist or movement disorder specialist prior to acceptance into the program. We cannot accept persons who have an inability to communicate verbally, are uncomfortable writing, or are unable using the Zoom platform. Please email Robert Cochrane at cochra58@unlv.nevada.edu with questions or to express your interest in participating.This program was made possible, in part, by a grant from the Parkinson’s Foundation. Thank you!

Keep on moving to (and making) music

The evidence that rhythm, movement, and making music continues to accumulate as a therapeutic approach to address the symptoms and Quality of Life issues related to Parkinson’s Disease (PD).

Today we look at an article just out in Frontiers of Human Neuroscience, titled

Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives  

Over the last quarter of a century, increasing research results point to rhythm and music as effective and useful tools for treatment and rehabilitation of people with neurological disorders. This article reviews the evidence for four different approaches, what the consensus is at the present time, and, of course, suggests future directions.

The authors look at four different approaches:

  1. Rhythmic Auditory Stimulation (RAS)
  2. Music-Supported Therapy (MST)
  3. Therapeutic Instrumental Music Performance therapy (TIMP) and
  4. Patterned Sensory Enhancement (PSE)

The consensus of recent meta-analyses and systematic reviews is that, for Parkinson’s Disease (PD), is that RAS is an effective tool for improving gait, stride, and speed – folks walk faster and with longer steps with RAS. Additionally, evidence is showing that it also reduces freezing of gait (FOG), improves balance and reduces the occurrence of falls.

Neither MST nor TIMP have been studied much beyond the rehabilitation of stroke patients. They involve practicing on a keyboard or drums, beginning with the patient’s comfort level and increasing in difficulty. Some studies have begun to be used to investigate effectiveness as treatments for PD.  Some have shown improvements in motor dexterity. More research is needed, but in the meantime, learning to play drums or keyboards can’t hurt, and may enrich one’s quality of life (QOL).

Growing evidence in neurological and brain imaging have shown increased activity in the auditory and motor areas of the brain, indicating that brain plasticity might be achieved through music and rhythmic interventions. The authors note that RAS has been well studied with stroke and PD populations, but not with other movement disorders and Alzheimer’s populations. In addition MST and TIMP have only begun to be investigated as a means of restoring fine motor coordination.

The authors also call for neuroimaging use in studies, to better understand the physiological basis of the rehabilitation process. They point out the gaps in research and hope to provide a framework for future research – not so much a roadmap, I would think, but a laying out of what we know and what we don’t know, and what kinds of studies are needed to answer the questions about what we don’t know..  They state that “musical rhythm is a powerful tool” for therapy, and our understanding and exploration of how it modulates brain networks is in the initial stages.

 In other words, “We’ve only just begun.”

Meanwhile: Don’t stop moving to the music.

 

Citation:
Braun Janzen T, Koshimori Y, Richard NM and Thaut MH (2022) Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives. Front. Hum. Neurosci. 15:789467. doi: 10.3389/fnhum.2021.78946

 

RBD and other things PD-related

Diagnosis of PD is often not made until a person is in their 60s. With all the attention that has been focused on the disease(s) in the last 20 years or so, I suspect that more people are getting diagnosed at an earlier age, although most cases of young onset PD are likely to be genetic in origin.

However, an “early” diagnosis may not be a timely diagnosis, as  the title of one opinion piece I read some time ago said (see link below).

It is now becoming apparent that “Parkinson’s”includes several categories of symptoms, not just rigidity, tremors, and gait, as shown in the table below::

Source for the following table, accessed 11/28/2021:  URL=https://www.frontiersin.org/article/10.3389/fneur.2020.00686

The problem is that treatment and diagnosis are often delayed until PD has already reduced Quality of Life for many folks.

Good evidence for the quality-of-life benefits of existing symptomatic treatment supports the argument for earlier diagnosis at a time when symptoms are already present (emphasis added). This argument would be significantly bolstered by the development of disease-modifying treatments. Benefits of early diagnosis and treatment would affect not only the individual (and their families) but also the wider society and the research community. Ultimately, however, shared decision-making and the principles of autonomy, beneficence, and non-maleficence will need to be applied on an individual basis when considering a “timely” diagnosis.

Therefore, the earlier one can predict the probability or inevitability of PD the sooner one can use treatments – whether pharmacological, surgical, nutritional, or lifestyle in nature – that can either reduce, delay, or defer (and possibly reverse?) the symptoms of PD.

Of all the symptoms associated with PD: tremors, bradykinesia, depression & anxiety, posture, gait issues (difficulties walking), REM Sleep Behavior Disorder (RBD), anosmia (loss of ability to smell), cognitive issues, facial masking, and micrographia (small handwriting) – RBD is the one which is most highly predictive of a later PD diagnosis.

The predictive ‘specificity’ is so strong that if someone has RBD, the chance of being diagnosed with Parkinson’s or related conditions over the next 15 years or more is over 80%

If an 18-21 year old person walked into a physician’s office with RBD, essential tremors, and depression as main symptoms, what would happen? In 1970, probably nothing – one might get treated for depression, but essential tremors are also called “benign”tremors, and were ignored, even if the patient reported being able to feel the tremors while resting, though invisible to the external observer. As for RBD, it would probably also be ignored.

By “a physician,” we are talking about a General Practitioner, or “family doctor,” and not s specialist like a  Movement Disorders Specialist who would be trained to identify varied symptoms, including those that are prodromal. And, of course, the identification of prodromal symptoms has only been investigated within the last decade or so, and are identified as for “research only” purposes – not for clinical diagnosis. A recent survey article (not referenced below) indicated that a majority of general practitioners were either unaware of the Movement Disorders Society’s list of prodromal symptoms, or were not using them to make referrals to Movement Disorders Specialists.

But thanks to the dedication and generosity of folks like Michael J. Fox and others, PD has become a respectable disease for which the person who has it has no reason to be apologetic or ashamed, and can hold their head up (and they ought to, since one symptom is to walk with shoulders stooped down) and proudly proclaim that they have Parkinson’s, which is why they walk funny. And so it goes.

Articles that were quoted above or which contributed to this article are found in the links below.

But first:

I See The Signs of PD

Perspective: Current Pitfalls in the Search for Future Treatments and Prevention of Parkinson’s Disease

An early diagnosis is not the same as a timely diagnosis of Parkinson’s disease

Prodromal REM Sleep Behavior Disorder and PD

10 Early Signs of Parkinson’s Disease / Parkinson’s Foundation

REM Sleep Behavior and Motor Findings in Parkinson’s Disease: A Cross-sectional Analysis

Current Update on Clinically Relevant Sleep Issues in Parkinson’s Disease: A Narrative Review

The prodromes of Parkinson’s disease

Exercise-Induced Neuroprotection of the Nigrostriatal Dopamine System in Parkinson’s Disease

###

Late Stage Parkinson’s (LSP): Undertreated?

This paper (or rather a chapter in a thesis) landed in my newsfeed recently. In it, the authors describe a study done to see whether people with Parkinson’s in the later stages are getting adequate treatment and whether they could benefit from more specific treatment. (A link to the PDf file is at the end of this post).

A person in Late Stage Parkinson’s has more than one of the following:

  • Motor symptoms not controlled despite medication.
  • Levadopa-related dyskinesias or dystonia,
  • PD dementia (defined according to MDS Task Force definition (Dubois et al. 2007), and
    not treated with cholinesterase inhibitors,
  • Depression not adequately treated,
  • Neuropsychiatric symptoms, such as agitation/ aggression; anxiety and irritability,
  • Orthostatic hypotension, pain, constipation, urinary symptoms, insomnia or daytime sleepiness (autonomic systems degeneration),
  • Falls on a regular basis,
  • Other symptoms related to risk of choking, speech issues, or producing too much saliva,
  • Inadequate Home environment.

Basically, the study provided a list of recommended activities and treatment on a sheet of paper (the control group) and actually providing the treatments and activities recommended, (the treatment group).

Not surprisingly, the treatment group did better at the end of the study than the controls. The conclusions were that people in late-stage Parkinson’s are often undertreated and could benefit from implementation of movement disorder specialists’ recommendations. (One would hope that the control group would also be provided with the treatments after the study ended. Perhaps, leading to another report)?

I’ve paraphrased the table used to describe late stage Parkinsonism in order not to infringe on their copyright. The title of the entire thesis is “Impairment and Disability in Late Stage Parkinsonism” and the overall author is Danny Hommel. I couldn’t find an email to ask for permission in writing to reproduce anything verbatim.

Other chapters include:

  • The late-stage of parkinsonism’s – motor and non-motor complications
  • The prevalence and determinants of neuropsychiatric symptoms in late-stage parkinsonism
  • Prevalence and prescribed treatments of orthostatic hypotension in institutionalized peoples with Parkinson’s disease (the chapter discussed in this post)
  • Optimizing treatment in undertreated late-stage parkinsonism: a pragmatic randomized trial
  • General discussion/English summary

Published as: ALAJ Hommel, MJ Meinders, NJ Weerkamp, C Richinger,
C Schmotz, S Lorenzl, R Dodel, M Coelho, JJ Ferreira, F Tison, T Boraud,
WG Meissner, K Rosqvist, J Timpka, P Odin, M Wittenberg, BR Bloem,
RT Koopmans, A Schrag and the CLaSP consortium.
Optimizing treatment in undertreated late-stage parkinsonism: a pragmatic
randomized trial.
J Parkinsons Dis. 2020;10(3):1171-1184.

Not a cure, but a biomarker

A biomarker for Parkinson’s?  Maybe… (If you don’t have a free ResearchGate account, yu might not be able t see this link):

A blood marker for Parkinson’s Disease: Neuronal exosome-derived α-synuclein

This isn’t in print yet, so I’ll just quote frm the abstract:

18 To date, no reliable clinically applicable biomarker has been established for Parkinson’s
19 disease (PD). Our results indicate that a long hoped blood test for Parkinson’s disease may
20 be realized. We here assess the potential of pathological α-synuclein originating from
21 neuron-derived exosomes from blood plasma as a possible biomarker. Following the
22 isolation of neuron-derived exosomes from plasma of PD patients and non-PD individuals
23 immunoblot analyses were performed to detect exosomal α-synuclein. Under native
24 conditions significantly increased signals of disease-associated α-synuclein forms in neuron25 derived exosomes were measured in all individuals with PD and clearly distinguished PD
26 samples from controls. By performing a protein misfolding cyclic amplification assay these
27 aggregates could be amplified and seeding could be demonstrated. Moreover, the
28 aggregates exhibited β-sheet-rich structures and showed a fibrillary appearance. Our study
29 demonstrates that the detection of pathological α-synuclein conformers from neuron-derived
30 exosomes from plasma samples has the potential of a promising blood-biomarker of PD.

Exosomes are small bundles of proteins  enclosed by a membrane (if I understand it correctly)(feel free to correct me- the Wikipedia article hd a note saying that it was too technical for most readers – and I agree).

Exosomes contain material from the cells from which they originated, so might be used as biomarkers. Obviously, it will take a while to fund the research and develop some way to determine how far along the way to developing PD someone is.  But the sooner a person can deal with it, the better the opportunity to live well with it. I look forward to the development of biomarkers that will help predict who might get Parkinson’s, so those folks can take preventive action.

I am fortunate that my symptoms did not appear in the usual sequence,and that I had DBS early after diagnosis, have had an outstanding medical team looking out for me and working with me, have a strong local community supporting people with Parkinson’s, and have a care partner who makes sure that my diet is full of organic foods, produce, and as few highly processed foods as possible. And I get lots of exercise, considering that I’m not athletic and I am not into weightlifting or bodybuilding.

Lucky me.

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